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Nursing on the critical list

Professor Ann Marie Rafferty has her say on the importance of the health select committee report into nursing, and why it’s crucial in the fight to save the profession.

This report makes for sober reading and should be read by every member of the cabinet, MPs of all parties, and members of the upper house.

It should be welcomed as a cool-headed and candid account of the scale and severity of the nursing crisis.

It is also written in such a way that the public will understand - a deft combining of data, infographics, numbers and narratives from nurses themselves, breathing life into what could otherwise have been a dull and desiccated repetition of the diagnoses of the past.

But this report speaks with a refreshing frankness. It is clear it has listened and issued a call to action.

“Reversal in cuts in CPD are to be welcomed, though the testimony of nurses themselves suggests there is a worrying, more deep-seated problem”

The Health Select Committee reveals the nursing crisis to be a many-headed hydra, defying any simple or single solution. The challenge is systemic and the report puts nursing clearly on the critical list.

It rightly emphasises retention, the biggest, most complex and multi-faceted disorder affecting the workforce. It welcomes the help that is underway but does not duck the seismic challenge of crossing the chasm to scale up help at speed.

Shifting the needle to the right requires decent data - and this is lacking; there is no agreed definition of ‘shortage’ and it rightly recommends this needs to be remedied and tracked to an agreed metric.

Reversal in cuts in CPD are to be welcomed, though the testimony of nurses themselves suggests there is a worrying, more deep-seated problem with workload and vacancy issues preventing nurses from accessing CPD and health and well-being initiatives even when provided. But it is the testimony and the telling phrase from frontline nurses, which stands out for me.

One describes the threat she feels to safety every time she goes on duty as putting her ‘PIN on the line’. One nurse’s reference to the ‘restless hamster wheel’ of practice sums up the pathology. It paints a picture of a profession suffering from akathisia.

“One can’t help but feel that, in the circumstances, ministers might look around for the triage nurses to initiate support. But will they be there to administer it?”

Readers with a mental health background will be familiar with the symptoms of akathisia as a ‘movement disorder characterised by a feeling of inner restlessness and a compelling need to be in constant motion’ - this is what prevents nurses taking their breaks, staying later and starting their shift earlier to make care ends meet.

The consequences for the health and well-being of nurses are both physical and psychological, most potently impacting the very psyche of the profession itself.

For me, this is the most profound aspect of the report. If nursing is on the critical list who is going to administer the life support?

The appeal is mainly made to government to weigh-in and take action. Others are also called upon to play their part. But this is a government consumed by Brexit, whose bandwidth is more than fully occupied with the biggest constitutional challenge facing post World War 2 Britain.

One can’t help but feel that, in the circumstances, ministers might look around for the triage nurses to initiate support. But will they be there to administer it?

The worst thing about akathisia and being caught in the restlessness of perpetual motion is that it stops you from thinking. We need to stop the akathisia, critically engage our brains and think our way out of the crisis.

For that is the only way we can get off the critical list.

Anne Marie Rafferty is professor of nursing policy at the Florence Nightingale faculty of nursing, midwifery & palliative care, King’s College London. She is an expert in workforce research and policy in healthcare and historian.

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